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CALIFORNIA     STATE     BOARD     OF     HEALTH 


-SPECIAL  BULLETIN  No.  21 


DENTAL  HYGIENE 


Public  Dental  Clinics  in  California 
and  Their  Purpose 


BT 


GUY  S.  MILLBERRY,  D.  D.  S. 

Dean  College  of  Dentistry 
University  of  California 


ISSUED  BY 

CALIFORNIA  STATE  BOARD  OF  HEALTH 

MARCH  1,  1917 


CALIFORNIA  STATE  PRINTING  OFFICE 

SACRAMENTO 

19  17 


PUBLIC    DENTAL    CLINICS    IN    CALIFORNIA   AND   THEIR 

PURPOSE. 

By  Gut  S.  Millberry,  D.D.S.,  Dean  of  the  College  of  Dentistry,  University  of 

California. 

This  wonderful  state  with  its  vast  resources,  its  varied  climatic 
conditions,  its  opportunity  for  living  out  of  doors,  offers  every  possible 
advantage  for  the  maintenance  of  good  health.  Good  health  is  essen- 
tial to  the  progress  of  humanity  and  the  achievement  of  individual 
success.  The  foundation  of  good  health  is,  first,  the  practice  of  hygienic 
methods  of  living,  whether  it  be  while  at  work,  at  rest,  or  during  our 
recreation;  and,  second,  the  effective  prevention  of  the  spread  of 
disease.  The  former  deals  primarily  with  the  individual,  the  latter 
largely  with  the  community. 


Sacramento  Public  School  Dental  Clinic. 

To  prevent  epidemics  which  may  impair  the  health  of  the  people  of 
a  community,  laws  are  enacted  in  the  form  of  quarantine  regulations, 
ordinances  to  prevent  the  pollution  of  water  and  milk  supplies,  pure 
food  laws,  etc.  The  health  of  a  given  locality,  however,  is  in  reality 
the  sum  total  of  the  health  of  the  individuals  in  that  locality.  The  care 
of  the  mouth  and  teeth  plays  a  very  important  part  in  this  phase  of 
public  health,  and  it  is  because  of  this  that  public  dental  clinics  have' 
been  established  in  many  cities  throughout  the  world. 

Nearly  all  of  the  diseases  which  flesh  is  heir  to  are  either  infectious 
diseases,  that  is  they  occur  as  a  result  of  bacterial  invasion,  or  they  are 
the  aftermath  of  some  previous  infection.  The  majority  of  them  find 
their  way  into  the  body  through  the  mouth  or  nose,  either  with  the  air 
we  breathe,  the  food  we  eat,  the  liquids  we  drink,  from  cooking  utensils, 
our  hands,  clothing,  etc.  Some  diseases  such  as  measles,  chickenpox, 
scarlet  fever,  smallpox,  and  other  skin  diseases,  if  acquired  during  the 
period  when  the  teeth  are  forming,  may  have  a  very  bad  effect  upon 
such  teeth,  producing  serious  defects  which  later  in  life  may  impair 
the  general  health  of  the  individual  or  mar  his  or  her  appearance. 


-  3 


The  conditions  under  which  disease  germs  thrive  most  favorably  are 
darkness,  moisture,  suitable  temperature,  and  food.  All  of  these  con- 
ditions are  to  be  found  in  the  mouth.  The  conditions  which  are  unfavor- 
able to  the  growth  of  these  germs  and  the  diseases  they  cause  are  clean- 
liness, and  normal  bodily  or  biologic  resistance,  the  latter  depending 
upon  the  state  of  health.  Cleanliness,  as  one  of  the  most  potent  factors 
in  maintaining  normal  health  and  mouth  hygiene  as  practiced  by  the 
individual,  is  no  exception  to  the  rule. 

Importance  of  Mouth  Hygiene. 

Sound  teeth  enable  one  to  properly  masticate  the  food  which  provides 

the  body  with  nourishment 
to  build  bodily  resistance. 
The  daily  cleansing  of  the 
mouth  and  teeth  removes 
large  numbers  of  disease 
producing  germs  which 
might  otherwise  find  their 
way  into  the  body  and 
cause  disease,  either  in  a 
brief  time  or  perhaps  aft^r  a 
long  time,  for  some  of  the 
diseased  conditions  in  remote 
parts  of  the  body,  having 
their  origin  in  the  mouth, 
may  have  had  their  begin- 
ning twenty-five  years  before 
the  symptoms  become  alarm- 
ing, so  insidious  are  these 
causes. 

The  tendency  in  the  estab- 
lishment of  dental  clinics 
has  been  to  educate  both  by 
precept  and  practice  in 
order  to  overcome  the  in- 
herent fear  which  all  people 
have  for  dental  operations. 
News  notices,  lectures  and, 
books  arouse  interest,  but 
they  are  not  as  effective  as  a  method  which  will  carry  the  teachings 
into  the  school  and  the  home.  There  is  a  natural  abhorrence  on  the 
part  of  many  people  to  read  or  discuss  matters  pertaining  to  health 
and  hygiene,  but  happily  we  are  awakening  to  a  realization-  that  knowl- 
edge and  not  ignorance  of  disease  is  the  best  safeguard  against  it. 
Lectures  do  not  have  the  same  effect  as  personal  contact  with  the 
individual,  for  the  individual  is  directly  concerned  with  his  own  health,. 
and  the  lesson  can  be  much  more  forcibly  impressed  without  encounter- 
ing as  much  skepticism  or  antagonism. 

The  most  important  thing  for  us  to  remember  is  that  practically  all 
dental  disorders  are  preventable.  This  applies  as  well  to  disease  in 
other  parts  of  the  body  as  may  have  originated  from  a  focus  of  infection 
in  the  mouth,  such  as  an  alveolar  abscess,  a  pyorrhoeal  pocket,  or  from 


San  Francisco  Public  School  Clinic, 
in  oral  hygiene. 


Instruction 


—  4  — 

an  insufficient  number  of  sound  masticating  teeth,  resulting  in  digestive 
disorders. 

The  prevention  of  dental  disorders,  and  their  sequelae,  may  be  divided 
into  two  orders  of  procedure.  First  and  most  important  is  the  practice 
of  mouth  hygiene  by  the  patient.  This  consists  of  brushing  the  teeth- 
carefully  at  least  twice  a  day  from  the  gums  toward  the  biting  surfaces 
with  a  rotary  motion  to  remove  all  the  food  debris  and  mucous  deposits. 


Main  operating  room  in  San  Quentin  State  Prison  Dental  Clinic. 

and  the  additional  u>se  of  a  mouth  syringe  or  floss  silk  for  cleansing 
the  surfaces  the  brush  does  not  reach.  The  second  procedure  includes 
such  prophylactic  treatment  as  may  be  given  by  the  dentist  in  removing 
the  hard  calcareous  deposits  and  stains,  and  restoring  to  normal  such 
teeth  as  may  require  operative  work. 

Value  of  Public  Dental  Clinic. 

If  the  daily  practice  of  mouth  hygiene  is  begun  early  in  childhood 
and  done  thoroughly,  and  frequent  regular  visits  are  made  to  the  dentist 
for  prophylactic  treatment  if  necessary,  there  is  very  little  danger  of 
decay  or  inflammatory  disturbances  occurring.  There  is  enough  evi- 
dence to  substantiate  this  statement,  even  though  90  per  cent  of  the 
people  are  afflicted,  because  they  are  either  uninformed  as  to  the 
importance  of  the  care  and  conservation  of  the  teeth,  or  they  are  unable 
to  afford  dental  service.  The  public  dental  clinic  will  supply  both  the 
information,  and  for  the  children  at  present,  dental  service. 

School  dental  clinics  originated  in  Europe.  From  the  "viewpoint  of 
municipal  interest  and  support  they  have  developed  rapidlj-  in  Germany 


and  England.  They  were  instituted  shortly  after  the  Boer  war,  when 
it  was  learned  that  not  only  a  large  number  of  regular  soldiers  were 
incapacitated  because  of  dental  disorders  but  that  most  of  the  recruits 
were  rejected  for  the  same  reason.  The  public  schools  being  the  prin- 
cipal assembling  places  for  the  classes  of  people  from  which  the  recruits 
were  drawn  it  was  decided  to  institute  preventive  measures  therein,  in 
order  that  the  health  of  the  common  people  might  be  conserved  as  a 
bulwark  to  the  nation,  both  in  war  and  industry. 

In  America,  while  there  are  many  more  cities  in  which  dental  clinics 
have  been  established  than  in  Europe,  the  majority  of  them  are  privately 
maintained  by  parent-teachers  organizations  or  dental  associations,  or 
they  are  endowed.  Their  permanence  and  usefulness  depend  entirely 
upon  municipal  support. 

Every  large  city  and  every  county  maintains  its  hospital  for  the  care 
of  the  indigent  sick,  but  very  few  maintain  a  dental  clinic  or  employ  the 
services  of  a  dentist  in  connection  therewith.  The  care  of  every  other 
human  ailment  is  provided  for  except  the  care  of  the  mouth  and  teeth, 
though  occasionally  a  tooth  may  be  extracted  by  a  surgeon  or  steward. 
Yet  many  of  the  diseases  which  are  responsible  for  the  patients  residence 
in  such  institutions,  at  the  expense  of  the  city  or  county,  are  due  to 
diseased  conditions  of  the  mouth,  and  are  not  eradicated  until  the  mouth 
is  put  in  order.  Is  it  not  better  to  provide  good  dental  service  for  those 
who  are  suffering  from  these  conditions? 

Physical  Development  Necessary. 

These  are  some  of  the  reasons  why  those  most  conversant  with  the 
problem  are  desirous  of  having  the  physical  development  of  the  child 
in  the  school  receive  as  much  consideration  as  his  mental  development. 
There  is  no  desire  to  interfere  with  the  rights  of  parents  or  the  influences 
of  the  home,  but  in  so  many  instances  it  has  been  found  that  the  parents 
were  ignorant  of  conditions,  so  that  it  was  advisable  to  recommend  or 
undertake  dental  treatment  in  justice  to  the  child.  The  terms  "medical" 
or  "dental  inspection"  should  not  be  used  in  connection  with  such 
health  and  hygiene  propaganda,  for  inspection  implies  an  interference 
with  one 's  personal  rights  or  liberties  and  though  usually  just,  is  seldom 
graciously  accepted.  I  believe  the  greatest  antagonism  to  these  move- 
ments has  been  aroused  by  the  use  of  the  word  inspection. 

In  California,  the  movement  began  in  1910  in  San  Francisco  and  Los 
Angeles,  the  initiative  being  taken  by  the  dental  societies  in  both  cities 
as  well  as  in  Sacramento,  Oakland,  Berkeley,  San  Jose,  Pasadena,  San 
Diego  and  other  cities  shortly  afterward.  Depending  on  voluntary  serv- 
ice, cheerfully  given  at  first  but  later  becoming  less  dependable,  they 
were  continued  with  variable  degrees  of  efficiency  or  were  discontinued 
altogether.  Renewed  agitation  and  the  pressing  need  of  dental  serv- 
ice for  certain  groups  of  children  aroused  further  interest  which  was 
extended  to  other  social  organizations  and  municipal  boards  with  the 
result  that  a  fairly  constant  or  improved  and  increasing  service  is 
being  rendered  to  those  most  in  need  and  unable  to  pay. 

Work  of  Dispensaries. 
The  social  and  civic  bodies,  such  as  parent-teachers  clubs,  have  been 
largely  instrumental  in  securing  funds  and  equipment  as  well  as  creat- 
ing municipal  interest  in  this  work.    They  were  wholly  instrumental  in 


—  6  — 

securing  a  fund  of  $45,000.00  for  the  erection  of  a  public  school  dis- 
pensar}'  in  Los  Angeles,  Mr.  0.  T.  Johnson  being  the  donor.  This 
new  dispensary,  opened  October  1,  1916,  is  given  over  to  the  care  of 
those  children  who  may  need  dental,  eye,  ear,  nose  or  throat  treatment. 
From  those  who  can  afford  to  pay  a  small  fee  is  collected,  the  other 
sources  of  revenue  for  general  maintenance  being  from  entertainments 
and  from  parent-teachers  circles.  The  salaries  of  three  dentists  and 
the  two  assistants  are  paid  by  the  Board  of  Education,  while  the  physi- 
cians give  their  services  without  compensation.  In  1915-16,  1,345  chil- 
dren were  cared  for,  involving  7,482  operations.    Twelve  thousand  cases 


Dental  Clinic  in  a  Department  Store,  San  Francisco. 

have  been  handled  in  the  past  five  years.  Along  with  this  work,  sys- 
temic instruction  in  mouth  hygiene  in  the  schools  is  being  inaugurated. 

In  San  Francisco  the  results  until  the  last  half  year  have  been  less 
satisfactory.  Undertaken  by  the  San  Francisco  District  Dental  Society 
with  the  aid  of  the  Associated  Charities  it  was  carried  on  for  two  years, 
then  continued  by  the  Associated  Charities  for  over  a  year  and  finally 
discontinued.  The  Congress  of  Mothers  revivified  the  interest  early  in 
1916  and  were  able  to  secure  an  appropriation  of  $3,000  from  the  board 
of  supervisors  for  the  fiscal  year  1916-17.  Two  dentists  and  two  assist- 
ants were  appointed  and  have  been  carrying  on  the  work  in  eleven 
different  schools.  During  three  and  a  half  months,  ending  Decem- 
ber 15,  1916,  1,255  operations  were  performed  on  368  pupils.  The  work 
has  been  carried  on  in  districts  where  the  need  was  greatest,  and  a  liberal 
allowance  of  time  has  been  spent  in  giving  instruction  to  the  classes  in 
mouth  hygiene. 

Sacramento  has  carried  on  a  most  effective  work.  Instituted  in  1911 
by  the  Board  of  Education,  a  well-equipped  and  liberally  maintained 
clinic  has  been  rendering  good  service  ever  since.  In  1916,  813  new- 
patients  were  registered  with  a  total  of  3,608  operations  to_  the  credit 
of  the  dentist  and  his  nurse.  An  average  of  seven  appointments  a 
day,  with  all  necessary  work  except  gold  work  being  done,  is  the  general 


—  7  — 

report.  San  Diego,  Pasadena,  Merced  and  Berkeley  have  regular 
clinics,  and  Stockton,  having  received  municipal  support,  is  just 
establishing  one. 

Emergency  and  Permanent  Service. 

While  this  character  of  public  dental  service  is  preventive,  in  that  it 
offers  instruction  in  mouth  hygiene,  as  well  as  providing  dental  service, 
there  are  a  number  of  public  dental  clinics  which  aim  to  provide  emer- 
gency and  permanent  service  for  the  relief  of  suffering,  in  institutions 
where  large  groups  of  people  are  housed  either  permanently  or  tempo- 
rarily. Without  such  service,  these  people,  at  times,  have  been  obliged 
to  suffer  excruciating  pain  from  dental  disorders. 

The  penal  institutions  at  San  Quentin  and  Folsom  now  provide  dental 
service.  It  was  instituted  in  1913.  To  quote  Warden  Johnston  in  a 
paper  recently  presented  before  the  San  Francisco  District  Dental 
Society,  speaking  of  the  health  of  the  inmates,  "while  physical  better- 
ment may  not  be  the  most  important,  it  is  the  most  necessary  in  that  it 
is  a  prerequisite  to  mental  and  moral  progress"  and  "how  they  ever 
managed  to  get  along  in  years  past  without  a  dentist  is  beyond  under- 
standing."  Every  person  is  examined  at  the  time  of  entrance  and  the 
condition  of  the  teeth  and  oral  cavity  noted.  The  records  show  that 
■91  per  cent  require  dental  attention.  A  complete  equipment,  modern 
in  every  detail,  affording  every  possible  facility  for  rapid  and  efficient 
service  and  for  the  relief  of  pain  is  provided. 

In  the  Juvenile  Detention  Home  in  San  Francisco  Mr.  J.  C.  Astredo 
has  installed  a  complete  dental  equipment.  At  present  the  appropria- 
tion permits  of  only  two  half -day's  service  a  week,  which  is  wholly 
inadequate.  Only  emergency  service  can  be  rendered  except  in  a  few 
instances  and  since  the  period  of  residence  is  generally  transient  the 
teaching  of  mouth  hygiene  is  not  as  effective  as  it  should  be.  However, 
the  health  department  as  at  present  organized,  will  be  able  to  improve 
these  conditions  in  time. 

Dental  Equipment  in  Hospitals. 

In  no  place  is  the  need  for  dental  equipment  and  service  greater  than 
in  the  large  hospitals.  Los  Angeles  recognized  this  several  years  ago 
and  has  had  a  dentist  on  the  permanent  staff  giving  full  time  service. 
During  the  fiscal  year  ending  July  1,  1916,  2,091  operations  were  per- 
formed. Included  in  this  were  14  fracture  cases.  Probably  no  feature 
of  this  service  is  more  important  than  the  eradication  of  septic  foci,  by 
removing  diseased  teeth  and  roots  and  giving  prophylactic  treatment 
prior  to  surgical  operations  upon  the  nose,  throat,  or  gastro-intestinal 
tract. 

At  Lane  Hospital,  Stanford  University  Medical  School,  a  dentist 
gives  half  time  service.  All  cases  in  the  orthopedic  clinic,  where 
diseased  teeth  are  suspected  as  being  a  primal  cause,  are  first  referred 
to  the  dental  clinic  for  radiographs,  and  such  prophylactic  or  surgical 
treatment  as  may  be  necessary  in  handling  the  case.  The  dental  clinic 
also  cooperates  with  the  nose  and  throat  clinic  in  handling  cases. 

At  the  San  Francisco  Hospital  a  resident  dentist  is  now  employed, 
giving  half  time  to  the  hospital  service  where  during  the  past  four 
months  505  operations  have  been  performed  for  182  patients  and  half 


8  — 


time  to  the  care  of  the  foster  mother  children,  whose  welfare  is  in  the 
hands  of  the  Associated  Charities.  Five  hundred  and  nine  operations 
have  been  performed  for  109  of  these  children,  about  one-fifth  of  the 
number  who  require  service. 

The  commercial  interests  of  the  state,  realizing  that  the  conservation 
of  the  health  of  their  employees  is  good  business  policy,  have  in  some 

instances  made  careful  pro- 
vision for  their  physical 
betterment.  A  department 
store  in  San  Francisco,  in 
conjunction  with  its  hos]")ital 
service  which  is  under  the 
supervision  of  the  Welfare 
Department,  has  rendered 
dental  service  gratuitously 
to  its  1,500  employees  for 
the  past  three  years.  An 
average  of  135  operations 
per  month  are  rendered  by 
the  dentist,  with  an  assist- 
ant giving  half  time  service, 
and  these  include  jjerma- 
nent  service  of  a  minor  char- 
acter, emergency  and 
prophylactic  service.  The 
employees  are  instructed 
collectively  by  illustrated 
lectures  as  well  as  individu- 
ally on  the  care  of  the  teeth 
by  the  dentist.  A  follow  up 
system  determines  whether  the  individual  patients  conform  to  t,he 
instruction  given.  Each  new  employee  in  undergoing  the  required 
physical  examination  is  referred  to  the  dentist  as  well. 

The  University  of  California  has  installed  at  the  Infirmary  on  the 
campus  at  Berkeley  two  dental  equipments  with  two  dentists  and  one 
nurse  in  full  time  service.  Physical  examination  includes  the  oral 
cavity  and  instruction  is  given  to  all  freshman  students  under  the 
Department  of  Hygiene. 


Berkeley  Public  School  Dental  Clinic. 


Public  Dental  Clinics  a  Necessity. 

Public  dental  clinics  are  just  as  necessary  for  the  physical  welfare  of 
humanity  as  are  hospitals.  The  conditions  which  necessitate  their 
establishment  are  more  prevalent  than  any  other  form  of  human  ailment 
and  though  usually  less  acute,  are  generally  more  insidious  than  all 
others.  It  is  the  generally  accepted  belief  that  all  dental  disorders  and 
their  sequelae  are  preventable,  so  that  from  an  economic  viewpoint  the 
establishment  of  school  and  other  public  dental  clinics  is  worth  careful 
consideration  as  a  profitable  investment  in  any  community. 


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